Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials

Abstract

BackgroundPulmonary arterial hypertension (PAH) is a progressive disorder characterized by hypertension in the pulmonary arteries. PAH leads to symptoms such as shortness of breath, dizziness, leg edema and chest pain, impacting heavily on quality of life. The aim of this systematic review and meta-analysis was to determine the effect of exercise training to improve physical fitness and functionality in patients with PAH.MethodsA search was conducted for controlled trials using the databases Medline, Embase, SPORT Discus and Cochrane Central Register of Controlled Trials. Studies were included if at least 80% of the participants presented with group 1 PAH and if the intervention consisted of an exercise training program of at least 3 weeks duration. Data were extracted on study quality, participant and exercise intervention characteristics, and outcomes. Data were pooled by the generic inverse variance method using random effect models and were expressed as weighted means and 95% confidence intervals (CI).ResultsOf 110 identified abstracts, 5 studies with 106 patients (exercise: 53; control: 53; mean age 49.7 years) were included. Disease severity ranged from mild to severe; 96 patients suffered from PAH, 10 patients had chronic thromboembolic pulmonary hypertension. Exercise training led to an increase in 6 minute walk distance (72.5 m; 95% CI 46.0 m to 99.1 m; p < 0.0001) and peak oxygen uptake (2.16 mL/kg/min; 95% CI 2.16 to 3.93; p = 0.02). No severe adverse events during exercise were reported.ConclusionsOur findings suggest that an exercise training program positively influences exercise tolerance and functional capacity in patients with PAH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0031-1) contains supplementary material, which is available to authorized users.

Beneficios del ejercicio en pacientes con hipertensión pulmonar: Revisión bibliográfica

“…La Hipertensión Pulmonar (HTP) una serie de patologías que generan un aumento progresivo en la resistencia vascular pulmonar y por ende, un incremento de la presión en arterias pulmonares 1 . La presión intravascular restringe el flujo de sangre a través de la circulación pulmonar 2-3 y el aumento de presión de la arteria pulmonar produce una sobrecarga ventricular derecha, hipertrofia y dilatación ventricular [2][3][4] .…”

“…La debilidad del cuádri-ceps juega un rol fundamental e independiente a indicadores cardiacos de limitación en pacientes con HTP 9 . La HTP produce manifestaciones como disnea, mareo, edema de extremidades inferiores y dolor torácico, lo que interfiere mucho con la realización de actividades de la vida diaria y lleva a deterioro de la calidad de vida 1 . La limitación en la realización de actividad física de estos pacientes se cree debida a una hipoperfusión relativa de las áreas bien ventiladas del pulmón, un umbral aeróbico bajo y a hipoxemia 8 .…”

“…La Hipertensión Pulmonar (HTP) es un desorden progresivo caracterizado por el incremento de la presión en arterias pulmonares 1 . Se caracteriza por cambios en la mayoría de las arterias pulmonares distales, lo que provoca un aumento de la resistencia vascular pulmonar, aumenta la presión y restringe el flujo de sangre a través de la circulación pulmonar [2][3] .…”

“…El aumento de presión de la arteria pulmonar produce una sobrecarga ventricular derecha, con hipertrofia y dilatación ventricular 2 . La HTP produce manifestaciones como disnea, mareo, edema de extremidades inferiores y dolor torácico, lo que interfiere mucho en la realización de actividades de la vida diaria y deterioro de la calidad de vida 1 . El ejercicio no se ha utilizado como terapia habitual en HTP debido a la percepción del riesgo de muerte súbita cardíaca y la posibilidad teórica de que el ejercicio podría conducir a un empeoramiento de la hemodinámica vascular pulmonar y deterioro de la función cardíaca derecha.…”

The spectrum of pulmonary arterial hypertension in adults with congenital heart disease: management from a physician and nurse specialist perspective

“…Patients should be urged to increase their levels of stamina slowly, through gradual low intensity aerobic exercise, avoiding isometric or sudden/strenuous effort. The advice can be prescriptive for some and there is, indeed, evidence that a tailored rehabilitation programme can greatly improve exercise capacity in PAH [44]. However simple advice on walking and swimming, combined with a healthy diet is acceptable.…”